Project 2 - Profiling and Incentives in Behavioral Health Care This research evaluates the contribution of provider profiling and incentives to improving the quality of managed behavioral health care. Combining a quasi-experimental interrupted time series and randomized-controlled designs, the study uses existing data from public sector general assistance (GA) clients who receive substance abuse treatment under the state of Connecticut' s managed behavioral health care (MBHC) program. In October 2001, the Connecticut Department of Mental Health and Addiction Services (DMHAS) initiated provider profiling. DMHAS incorporates four standards of care and effectiveness measures into the contracts of all 452 providers (sites) who provide substance abuse and mental health services to approximately 25,000 GA clients per year. The profiles measure each provider's success in enhancing continuity of care, avoiding rapid readmissions to acute treatment services, documenting treatment plans, and referring high-risk clients appropriately. Every 4 months, DMHAS gives all providers written profiles measuring their performance and will offer technical assistance. To test a package of incentives, about 6 months after the start of this research, all providers will be randomly divided by region into incentives and control groups. Providers in the incentives group will be rewarded with administrative, referral, recognition, and financial incentives (for detox providers) for performing well. After 2 years, DMHAS will reverse the incentive and control areas. Brandeis will evaluate changes in provider performance, client "transitions" and treatment costs using client level data from DMHAS administrative data through multivariate regression. Process changes will be monitored through site visits and provider surveys as part of this study.